The Normal Endometrium

  • Tricia A. Murdock
  • Emanuela F. T. Veras
  • Robert J. Kurman
  • Michael T. Mazur


The histologic features of what constitutes “normal” endometrium change with a woman’s age, through the premenarchal, reproductive, perimenopausal, and postmenopausal years. Throughout the reproductive years, the cyclical hormonal changes of the menstrual cycle provide a continuously changing morphologic spectrum from proliferative to secretory to menstrual phenotypes which is considered “normal.” Once menopause is reached, the presence of only rare strips of atrophic epithelium in biopsy/curettage sampling becomes the new “normal.” The same “normal” in a postmenopausal woman would be deemed “abnormal” in a premenopausal woman or, alternatively, would raise the possibility of exogenous hormonal effect. Likewise, finding only cervical or lower uterine segment tissue in a woman known to have an ultrasonographic lesion such as thickened endometrium supports under sampling. These examples emphasize the importance of clinical information including patient’s age and hormonal status. In biopsy specimens, the combination of these cyclical changes along with potential processing artifacts, limited sampling, or the presence of mimics can make normal patterns difficult to interpret. Deviations from normal, either in histologic pattern or in temporal relationship to ovulation, often indicate underlying abnormalities that may contribute to female infertility and abnormal uterine bleeding.


Endometrial biopsy Endometrial dating Endometrial histology 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Tricia A. Murdock
    • 1
  • Emanuela F. T. Veras
    • 1
  • Robert J. Kurman
    • 1
  • Michael T. Mazur
    • 2
  1. 1.Department of PathologyThe Johns Hopkins HospitalBaltimoreUSA
  2. 2.Department of Pathology and Laboratory MedicineState University of New York Upstate Medical UniversitySyracuseUSA

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